Provider Demographics
NPI:1932226305
Name:DELONG, JENNIFER MARIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIE
Last Name:DELONG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6341
Mailing Address - Fax:239-343-6342
Practice Address - Street 1:16271 BASS RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3616
Practice Address - Country:US
Practice Address - Phone:239-985-1925
Practice Address - Fax:239-468-7929
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9326030363L00000X
OHCOA.09303-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4461784OtherCIGNA
FL9929331OtherAETNA
OH2785786Medicaid
FLP1002746OtherFREEDOM
FLP954560OtherOPTIMUM
FLY08QBOtherBCBS OF FL
FL004206800Medicaid
FLBCBSOtherY08QB
FLP01318562OtherRR MEDICARE
FL1233501OtherWELLCARE
FLP01318562OtherRR MEDICARE